- Wiley Online Library

Pain Medicine 2011; 12: 1544–1550
Wiley Periodicals, Inc.
Brazilian Portuguese Validation of the Leeds
Assessment of Neuropathic Symptoms and
Signs for Patients with Chronic Pain
pme_1221
Pedro Schestatsky, MD, PhD,* Vitor Félix-Torres,
MD,* Márcia Lorena Fagundes Chaves, MD, PhD,*
Betânia Câmara-Ehlers, MD,* Tamara Mucenic,
MD,† Wolnei Caumo, MD, PhD,‡
Osvaldo Nascimento, MD, PhD,§ and
Michael I. Bennett, MD¶
*Neurology Service,
†
Rheumatology Service, and
‡
Pain and Palliative Care Service, Hospital de Clínicas
de Porto Alegre, Porto Alegre, Brazil;
§
Department of Neurology, Fluminense Federal
University, Niterói-RJ, Brazil;
¶
School of Health and Medicine, Bowland Tower East,
Lancaster University, UK
Reprint requests to: Dr. Pedro Schestatsky, MD, PhD,
Hospital de Clínicas de Porto Alegre, Neurology
Department, EMG Unit, Rua Ramiro Barcelos,
2350—CEP 90035-003, Brazil. Tel: 513-359-8564; Fax:
513-359-8083; E-mail: [email protected].
Our work did not receive any financial support. All
authors declare no conflict of interests.
Abstract
Background. Neuropathic pain (NP) is a very frequent and unrecognized condition in clinical practice. Therefore, it is important to have a reliable
instrument to assess pain subtypes in various
cultures. The Leeds Assessment of Neuropathic
Symptoms and Signs (LANSS) has been widely
used and validated in many countries. Up to now,
there has been no reliability study of this instrument in Brazil.
Methods. The scores of the Brazilian Portuguese
version of the LANSS were studied in a sample of 90
chronic pain outpatients from southern Brazil.
LANSS was translated into Portuguese and then
back translated to English. Intraclass correlation
coefficient (ICC) and internal consistency (IC) were
estimated. The intensity of pain complaints, other
1544
1544..1550
demographic data, and LANSS scores distribution
according to pain subtypes (nociceptive, neuropathic, and mixed) were also evaluated.
Results. The Brazilian Portuguese version of the
LANSS showed good ICC (r = 0.97) and IC (Cronbach’s a = 0.67 for total LANSS score). Patients with
NP provided significant higher LANSS scores
(19.1 ⫾ 3.3) in comparison with those with nociceptive (7.3 ⫾ 4.5) and mixed (13.9 ⫾ 3.7) types of pain.
Conclusions. This LANSS version was found to
be a reliable instrument for the evaluation of pain
complaints due to a variety of causes. The profile of
pain scores was similar to that observed in other
countries.
Key Words. Brazilian Portuguese Validation; Neuropathic Pain; Nociceptive Pain; LANSS
Introduction
Neuropathic pain (NP) is defined as pain initiated by a
lesion or dysfunction of the somatosensory system as a
result of abnormal activity of the nociceptive pathway
[1,2]. Distinguishing nociceptive pain from NP is not only
an academic issue [3]. This is important for the establishment of etiology, prognosis, and specific therapeutic strategies for chronic pain. However, this is not an easy task in
clinical practice as the poorly myelinated fibers involved in
NP are not detectable by conventional nerve conduction
studies [4]. Apart from that, verbal descriptors for NP are
quite imprecise. Recently, several assessment tools have
been developed to aid in the diagnosis of NP [5–10].
Among the above-mentioned tools, the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain
scale is probably the easiest one to be used in clinical
practice [6]. This scale proposes the use of the terms such
as “pain of predominant neuropathic” or “pain of predominant nociceptive” types [11] as the coexistence of neuropathic and nociceptive pain is frequent in the same
patient.
The pattern of painful symptoms may differ among various
ethnic and cultural groups; therefore, it is important to
have a reliable instrument to assess pain complaints in
various settings. The LANSS scale has been validated for
several languages, such as Spanish [12] and Turkish [13].
Validation of the LANSS Scale for Brazilian Portuguese Language
However, no parameters of validation have been published for a Brazilian Portuguese version of LANSS yet.
This study aimed to evaluate the intraclass correlation
coefficient (ICC) and internal consistency (IC) of the Brazilian Portuguese version of the LANSS scale and also to
assess the capability of the Brazilian LANSS version in
discriminating different types of pain.
Methods
A cross-sectional study was conducted in a sample of
chronic pain patients selected by consecutive referrals to
the Neuromuscular and Rheumatology Clinics of Hospital
de Clínicas de Porto Alegre, Brazil. The diagnosis of NP
was done through clinical and laboratorial criteria [2], i.e.,
diabetic neuropathy or postherpetic neuralgia. Nociceptive pain was considered when there was clinical and/or
laboratorial evidence of nonneural tissue damage, i.e.,
osteoarthritis (positive X-ray plus swollen joints) or myofascial pain (compatible history with presence of trigger
points) and with normal electrophysiological studies.
Patients with mixed types of pain were those with both
neural and nonneural tissues involved, i.e., radiculopathy
or carpal tunnel syndrome. Eligibility criteria also included
age more than 18 years, Portuguese native speaker from
Brazil, and having chronic pain, defined as pain of more
than 3 months in duration.
The original English versions of the LANSS scale was
translated into Brazilian Portuguese by two Portuguese
native speakers who work in the area of neurology and are
both fluent in English. Those neurologists adapted some
expressions according to cultural Brazilian peculiarities.
Subsequently, the Brazilian Portuguese version was back
translated into English by an English native speaking physician who has been living in Brazil for the past 3 years.
Final adaptations were carried out further to ensure full
cultural and educational comprehension, and this version
was sent to the original author (MIB) for corrections (see
final Portuguese version in Appendix 1).
The LANSS scale consists of a total of seven items including a five-item questionnaire regarding pain symptoms
and two items involving sensory tests for the presence of
allodynia and decreased sensation to pinprick [6,14]. For
pinprick testing, a 23-gauge needle was supported in a
syringe barrel perpendicularly placed in contact with the
patient’s skin for several times so that only the mass could
exert downward pressure and not the examiner. Hyperalgesia was judged to be present when pinprick testing
elicited an exaggerated painful response at the index site
compared with the control site. Allodynia was also judged
to be present when pain was elicited by gently stroking a
piece of cotton wool over the index site and when normal
sensation was experienced in the control site.
Responses to the items were a “yes or no” type and were
weighted differently depending upon the question.
Responses are then summed to calculate a total score
from 0 to 24. Scores below 12 suggested pain with noci-
ceptive predominance, whereas scores above 12 suggested pain with neuropathic predominance.
Additionally, we also noted demographic variables, as well
as visual analog scale for pain intensity (VAS-INT) and
visual analog scale for impact on activities of daily living
(VAS-ADL) in the last 2 months. The study was approved
by the Ethic Committee for Medical Research of the Hospital de Clínicas de Porto Alegre. All patients signed an
informed consent before being enrolled into the study.
Procedure
The interviews followed the same structure and scoring
methods described in the original English versions [6], and
they were performed twice by two trained and independent neurologists. The evaluators (PS and VFT) were blind
to the disease of the patient and to the results of LANSS
scores obtained by each other. The interviews were made
with an interval of at least 1 day between them.
Data Reduction and Statistical Analyses
Descriptive statistics (mean, standard deviation, and frequency) were calculated for demographic data and
LANSS scores. The patients were grouped into three:
those with nociceptive, neuropathic, and mixed types of
pain. LANSS scores were then compared using ANOVA
followed by Bonferroni’s test. Correlation coefficients were
estimated for the ICC on the total LANSS, and IC was
analyzed by Cronbach’s a coefficient. A P value <0.05
was considered as statistically significant.
Results
There were no significant differences regarding sex, age,
years of education, and VAS-INT scores between groups
(nociceptive, neuropathic, and mixed ones). However,
patients with NP had significant higher scores of VAS-ADL
in comparison with those with nociceptive and mixed
types of pain. Indeed, there was a moderate correlation
between LANSS scores and VAS-ADL (r2 = 0.46;
P < 0.001) and a weak correlation between LANSS scores
and VAS-INT (r2 = 0.29; P = 0.006). Table 1 shows the
demographic characteristics of groups, whereas Table 2
shows the clinical conditions of all patients according to
their pain classification.
The ICC for the two independent evaluators was r = 0.97
(P < 0.001) and Cronbach’s a coefficient for IC was 0.67
for the total LANSS score (P = 0.001).
LANSS total scores were different between groups
(F[2,87] = 82.24; P < 0.001). Post hoc analysis showed
that differences were due to higher scores in NP patients
(19.1 ⫾ 3.3) followed by nociceptive (7.3 ⫾ 4.5) and
mixed (13.9 ⫾ 3.7) pain patients (Bonferroni’s test < 0.001
for all comparisons). Figure 1 shows the distribution of
LANSS according to pain subtypes.
1545
Schestatsky et al.
Table 1 Pain classification based on etiology (number of patients in parenthesis)
Neuropathic Pain (34)
Mixed Pain (12)
Nociceptive Pain (44)
Polyneuropathies (21)
— Diabetic (9)
— Infectious (9)
— Alcohol (1)
— Drug induced (1)
— Idiopathic (1)
Trigeminal neuralgia (3)
Postherpetic neuralgia (2)
CRPS I (2)
CRPS II (2)
Traumatic nerve injury (2)
Phantom limb (1)
Idiopathic plexopathy (1)
Radiculopathy (8)
Entrapment (4)
Osteoarthrosis (18)
Myofascial (15)
Low back pain (4)
Rheumatoid arthritis (3)
Ankylosing spondylitis (1)
Plantar fasciitis (1)
Gout (1)
Bursitis (1)
CRPS = complex regional pain syndrome; HIV = human immunodeficiency virus.
Table 2 Demographic data according to pain classification
Age (ys)
Weight (kg)
Height (cm)
Education (year)
VAS-INT (0–10)
VAS-ADL (0–10)
Nociceptive (N = 44)
Mixed (N = 12)
Neuropathic (N = 34)
P
55.5 ⫾ 14.2
71.7 ⫾ 14.7
165.4 ⫾ 9.8
8.7 ⫾ 3.3
6.7 ⫾ 2.2
5.9 ⫾ 2.6
48.7 ⫾ 10.6
77.1 ⫾ 11.7
170.5 ⫾ 7.2
6.9 ⫾ 3.1
6.9 ⫾ 2.5
6.8 ⫾ 2.5
54.0 ⫾ 12.0
73.1 ⫾ 15.0
168.2 ⫾ 9.5
9.4 ⫾ 3.7
7.6 ⫾ 1.5
7.5 ⫾ 2.1
0.2
0.5
0.1
0.1
0.1
0.03
VAS-ADL = visual analog scale for impact on activities of daily living; VAS-INT = visual analog scale for pain intensity.
The Pearson coefficient correlation was 0.89 (P = 0.01) for
the total LANNS scores between the assessment of two
independent evaluators. Indeed, there were no differences
regarding the mean LANSS score between the first and
second interviews (12.8 ⫾ 6.5 vs 12.6 ⫾ 6.8; Student’s
t-test; P = 0.6).
Discussion
Our study of the Brazilian Portuguese version of the
LANSS has demonstrated that is a reliable instrument.
Indeed, both ICC and Cronbach’s coefficient were as
good as those obtained by Spanish [12] and Turkish [13]
groups. We also found that NP is one of the most disabling types of pain in terms of the impact on the activities
of daily living in comparison with nociceptive and mixed
subtypes, and this illustrates the importance of an accurate diagnosis of pain.
Figure 1 LANSS
classification.
1546
scores
according
to
pain
Distinguishing NP from nociceptive pain is difficult for
several reasons [15]. First, the perception of NP is purely
subjective, which means that despite the use of the most
sophisticated equipment, NP intensity cannot be measured. Second, in contrast to other sensory systems, the
pain system is not static, but on contrary, it changes in a
dynamic and somewhat unpredictable fashion whenever
the system is activated. Third, signs and symptoms of NP
may change during the course of the disease if it becomes
chronic. Finally, neuropathic and nociceptive mechanisms
may coexist, and the clinician must decide whether neu-
Validation of the LANSS Scale for Brazilian Portuguese Language
ropathic mechanisms predominate in the patient’s overall
pain experience [11]. Therefore, when diseases or disorders are dominated by subjective symptoms, and the
associated clinical signs are few or absent, the requirement for diagnostic screening tools becomes crucial.
One of the advantages of screening tools, such as the
LANSS scale, is that they can also be used by nonspecialists, and this is important because the estimated
prevalence of NP can reach 8% in the general population
[16]. As they are very easy to use by both clinicians and
patients, these instruments are very attractive because
they provide immediate and reliable information. However,
pain descriptors themselves cannot make the diagnosis
by themselves [8] and, indeed, screening tools do not
identify about 10–20% of patients with NP [17]. If patients
with NP are detected, clinicians should then undertake
further assessment [18,19], which might affect subsequently diagnostic and therapeutic approaches [20].
In clinical practice, sometimes patients with nociceptive
pain can be misdiagnosed as having NP [17]. In our study,
for instance, several patients with clear musculoskeletal
disorders answered “yes” to question number 5 addressing burning sensation. Indeed, burning sensation is not
discriminative of NP [6,15] and can also be present in
patients with osteoarthritis. Therefore, according to the
LANNS scale, such a descriptor received low weight for
supporting the NP diagnosis. Sometimes, low-level education subjects can misinterpret questions regarding
sensory symptoms [21]. In our study, however, there were
no significant differences in years of education between
groups, reflecting the lack of influence of education levels
for pain diagnosis using the LANSS.
The LANSS scale was able to differentiate patients with
neuropathic, nociceptive, and mixed types of pain. This is
very important for clinical studies of analgesic drugs. Inclusion in trials of patients with mixed pain, instead of NP,
would usually be inappropriate and could explain the usual
refractoriness of NP drugs [2]. It is important to stress that
NP and other types of pains are often present in the same
patient and that LANSS can help in identifying such conditions. The coexistence of different types of pain can
influence the results of drug trials; i.e., patients with mixed
pain may not respond to antiepileptic drugs as much as
patients with pure NP. For example, as Backonja pointed
out [7], patients with diabetic neuropathy affecting the
distal legs may also have some inflammatory pain from
diabetic ulcer, and this could explain the reason why an
anti-NP drug is refractory in some cases of painful diabetic
neuropathies. In the same way, Treede et al. [2] recommend that more stringent criteria should be used in drug
trials than those used in epidemiological studies. Indeed,
its inclusion in trials involving patients with possible, rather
than definitive or probable, NP, i.e, LANSS scores below
20 points, would be inappropriate for the assessment of
drug efficacy.
In the last few years, many common diseases and intake
of drugs have been linked with NP because of small fiber
lesions, such as human immunodeficiency virus infection
[22], prediabetes [23], hypothyroidism [24], alcoholism
[25], hyperlipidemia [26], statin [27], and metformin [28]
use. Indeed, the most common cause of polyneuropathy,
the chronic idiopathic axonal form, is recognized by small
fiber affectation and NP in the early phases of a disease
[29]. Therefore, because chronic pain is also very
common in the general population, the use of LANSS
could also help to diagnose such conditions in clinical
practice. For instance, patients with chronic pain and
high LANSS scores should be more carefully watched
and investigated.
The LANSS scale application has received some criticism regarding methodological concerns, especially
about the safety of the pinprick test [30]. Differently
from Dr. Backonja and Dr. Krause’s experience [31], we
did not have any skin bleeding episodes during the
23-gauge needle examination in our 90 patients, in the
same way as Bennett’s [6] and other authors’ [12,13]
experiences. In any case, a 23-gauge needle used in the
LANSS assessment can be alternatively replaced by 1-g
monofilaments [32] in patients with thin and fragile skin
such as the elderly or in patients with complex regional
pain syndrome.
Our study has some limitations. First, our sample size was
only of moderate size, and it was drawn from only one
clinic, which may limit the ability to generalize the findings
to all settings. However, we adapted carefully the LANSS
for the patients’ understanding. Also, we used two assessors instead of only one, who were blind to each other’s
findings, and this contributed to the strength of our work.
Second, we did not include other important clinical
parameters such as impact of pain on sleep and quality of
life. However, the VAS-ADL could have been roughly provided similar information. Third, we retested patients in a
relatively short period of time, and this could have induced
a memory bias to the LANSS answers. However, if longer
intervals of retesting were used, progression or regression
of the disease may have been seen, compromising the IC
of our results.
In conclusion, the Portuguese version of the LANSS scale
from Brazil is reliable for use in clinical practice and
research. This is an important achievement because the
information taken from the LANSS is vital to understand
the distribution, etiology, and natural history of NP.
Acknowledgment
The authors would like to thank Vânia Naomi Hirakata,
statistician of the Hospital de Clínicas de Porto Alegre.
References
1 Merskey H, Bogduk N, eds. Classification of Chronic
Pain. Descriptions of Chronic Pain Syndromes and
Definitions of Pain Terms. Seattle, WA: IASP Press;
1994:209–12.
1547
Schestatsky et al.
2 Treede RD, Jensen TS, Campbell JN, et al. Neuropathic pain: Redefinition and a grading system for
clinical
and
research
purposes.
Neurology
2008;70:1630–5.
3 Schestatsky P, Nascimento OJ. What do general neurologists need to know about neuropathic pain? Arq
Neuropsiquiatr 2009;67:741–9.
4 Schestatsky P, Gerchman F, Valls-Solé J. Neurophysiological tools for small fiber assessment in painful diabetic neuropathy. Pain Med 2009;10:601.
5 Galer BS, Jensen MP. Development and preliminary
validation of a pain measure specific to neuropathic
pain: The neuropathic pain scale. Neurology 1997;
48:332–8.
6 Bennett M. The LANSS pain scale: The Leeds assessment of neuropathic symptoms and signs. Pain
2001;92:147–57.
7 Backonja MM, Krause SJ. Neuropathic pain
questionnaire—Short form. Clin J Pain 2003;19:
315–3.
8 Krause SJ, Backonja MM. Development of a neuropathic pain questionnaire. Clin J Pain 2003;19:306–
14.
9 Bouhassira D, Attal N, Fermanian J, et al. Development and validation of the Neuropathic Pain Symptom
Inventory. Pain 2004;108:248–57.
10 Bouhassira D, Attal N, Alchaar H, et al. Comparison of
pain syndromes associated with nervous or somatic
lesions and development of a new neuropathic pain
diagnostic questionnaire (DN4). Pain 2005;114:29–
36.
11 Bennett MI, Smith BH, Torrance N, Lee AJ. Can pain
can be more or less neuropathic? Comparison of
symptom assessment tools with ratings of certainty by
clinicians. Pain 2006;122:289–94.
12 Pérez C, Gálvez R, Insausti J, et al. Adaptación
lingüística y validación al castellano de la escala
LANSS para el diagnóstico diferencial del dolor neuropático. Med Clin 2006;127:485–91.
13 Yucel A, Senocak M, Orhan EK, Cimen A, Ertas M.
Results of the leeds assessment of neuropathic symptoms and signs pain scale in turkey: A validation study.
J Pain 2004;5:427–32.
14 Weingarten TN, Watson JC, Hooten WM, et al. Validation of the S-LANSS in the community setting. Pain
2007;132:189–94.
1548
15 Jensen TS, Baron R. Translation of symptoms and
signs into mechanisms in neuropathic pain. Pain
2003;102:1–8.
16 Torrance N, Smith BH, Bennett MI, Lee AJ. The epidemiology of chronic pain of predominantly neuropathic origin. Results from a general population
survey. J Pain 2006;7:281–9.
17 Cruccu G, Sommer C, Anand P, et al. EFNS guidelines on neuropathic pain assessment: Revised 2009.
Eur J Neurol 2010;17:1010–8.
18 Rasmussen PV, Sindrup SH, Jensen TS, Bach FW.
Symptoms and signs in patients with suspected neuropathic pain. Pain 2004;110:461–9.
19 Dworkin RH, Jensen MP, Gammaitoni AR, Olaleye
DO, Galer BS. Symptom profiles differ in patients with
neuropathic vs non-neuropathic pain. J Pain
2007;8:118–26.
20 Baron R, Binder A, Wasner G. Neuropathic pain: Diagnosis, pathophysiological mechanisms, and treatment. Lancet Neurol 2010;9:807–19.
21 Shavers VL, Bakos A, Sheppard VB. Race, ethnicity,
and pain among the U.S. adult population. J Health
Care Poor Underserved 2010;21:177–220.
22 Obermann M, Katsarava Z, Esser S, et al. Correlation
of epidermal nerve fiber density with pain-related
evoked potentials in HIV neuropathy. Pain 2008;138:
79–86.
23 Ziegler D, Rathmann W, Dickhaus T, Meisinger C,
Mielck A; KORA Study Group. Neuropathic pain in
diabetes, prediabetes and normal glucose tolerance:
The MONICA/KORA Augsburg Surveys S2 and S3.
Pain Med 2009;10:393–400.
24 Ørstavik K, Norheim I, Jørum E. Pain and small-fiber
neuropathy in patients with hypothyroidism. Neurology
2006;67:786–91.
25 Koike H, Mori K, Misu K, et al. Painful alcoholic polyneuropathy with predominant small-fiber loss and
normal thiamine status. Neurology 2001;56:1727–32.
26 McManis PG, Windebank AJ, Kiziltan M. Neuropathy
associated with hyperlipidemia. Neurology 1994;44:
2185–6.
27 Lo YL, Leoh TH, Loh LM, Tan CE. Statin therapy and
small fibre neuropathy: A serial electrophysiological
study. J Neurol Sci 2003;208:105–8.
28 Wile DJ, Toth C. Association of metformin, elevated
homocysteine, and methylmalonic acid levels and
clinically worsened diabetic peripheral neuropathy.
Diabetes Care 2010;33:156–61.
Validation of the LANSS Scale for Brazilian Portuguese Language
29 de Schryver EL, van Schelven LJ, Notermans NC, de
Valk HW, Oey PL. Small-fibre neuropathy can be
detected in patients with chronic idiopathic axonal
polyneuropathy. Eur J Neurol 2011;18:1003–5.
31 Backonja MM. Need for differential assessment
tools of neuropathic pain and the deficits of LANSS
pain scale (comment letter). Pain 2002;98:229–30.
30 Backonja MM. Need for differential assessment tools
of neuropathic pain and the deficits of LANSS pain
scale. Pain 2002;97:229–34.
32 Bennett M. Need for differential assessment tools of
neuropathic pain and the deficits of LANSS pain scale
(author reply). Pain 2002;98:230–31.
Appendix 1:
Portuguese Version from Brazil of LANSS Scale
Nome: __________________________Data: ____________________________
Esta escala de dor ajuda a determinar como os nervos que carregam a informação de dor estão funcionando. É
importante obter este tipo de informação, pois ela pode ajudar na escolha de um tratamento específico para o seu tipo
de dor.
A. QUESTIONÁRIO DE DOR
• Pense na dor que você vem sentindo na última semana.
• Por favor, diga se qualquer uma das características abaixo se aplica a sua dor. Responda apenas SIM ou NÃO.
1. A sua dor se parece com uma sensação estranha e desagradável na pele? Palavras do tipo “agulhadas,” “choques
elétricos” e “formigamento” são as que melhor descrevem estas sensações.
a. NÃO—Minha dor não se parece com is . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . [0]
b. SIM—Eu tenho este tipo de sensação com freqüência . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . [5]
2. A sua dor faz com que a cor da pele dolorida mude de cor? Palavras do tipo “manchada” ou “avermelhada ou rosada”
descrevem a aparência da sua pele.
a. NÃO—Minha dor não afeta a cor da minha pele . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . [0]
b. SIM—Eu percebi que a dor faz com que minha pele mude de cor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . [5]
3. A sua dor faz com a pele afetada fique sensível ao toque? A ocorrência de sensações desagradáveis e/ou dolorosas
ao toque leve ou mesmo ao toque da roupa ao vestir-se descrevem esta sensibilidade anormal.
a. NÃO—Minha dor não faz com que minha pele fique mais sensível nesta área . . . . . . . . . . . . . . . . . . . . . . . . . [0]
b. SIM—Minha pele é mais sensível ao toque nesta área . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . [3]
4. A sua dor inicia de repente, sem nenhuma razão aparente, quando você está parado? Palavras tipo “choques
elétricos,” “dor em pontada” ou “dor explosiva” descrevem estas sensações.
a. NÃO—Minha dor não é sentida desta forma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . [0]
b. SIM—Eu tenho estas sensações com muita freqüência . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . [2]
5. A sua dor faz com que a temperatura da sua pele na área dolorida mude? Palavras tipo “calor” e “queimação”
descrevem estas sensações.
a. NÃO—Eu não tenho este tipo de sensação . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . [0]
b. SIM—Eu tenho estas sensações com freqüência . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . [1]
B. EXAME DA SENSIBILIDADE: A sensibilidade da pele pode ser examinada comparando-se a área dolorida com a área
contralateral ou nas áreas adjacentes não-doloridas avaliando a presença de alodinia e alteração do limiar de
sensação ao estímulo da agulha (LSA).
6. ALODINIA: Examine a resposta ao toque leve com algodão sobre a área não-dolorida e, a seguir, na área dolorida.
Caso sensações normais forem percebidas no lado não-dolorido e, ao contrário, se dor ou sensações desagradáveis
(sensação tipo “picada” ou “latejante”) forem percebidas na área afetada, então a alodinia está presente.
a. NÃO—Sensação normal em ambas as áreas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . [0]
b. SIM—Alodinia somente na área dolorida . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . [5]
1549
Schestatsky et al.
7. ALTERAÇÃO DO LIMIAR POR ESTÍMULO DE AGULHA (LEA)
a. Determine o LEA através da comparação da resposta a uma agulha de espessura 23 (cor azul) conectada a
uma seringa de 2 mL—sem a parte interna—suavemente colocada nas áreas doloridas da pele e depois nas
não-doloridas.
b. Caso uma sensação de agulhada normal for sentida na área da pele não-dolorida, mas uma sensação diferente
for sentida na área dolorida como, por exemplo “nenhuma sensação” ou “somente sensação de toque” (LEA
aumentado) ou “dor muito intensa” (LEA diminuído), isso significa que há um LEA alterado.
c. Caso a sensação de agulhada não for percebida em nenhuma área, conecte a parte interna da seringa à agulha
para aumentar o peso e repita a manobra.
a. NÃO—Sensação igual em ambas áreas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . [0]
b. SIM—Limiar por estímulo de agulha alterado no lado dolorido . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . [3]
ESCORE:
Some os valores entre parênteses nos achados descritivos e de exame da sensibilidade para obter um escore global
ESCORE TOTAL (máximo 24): ________________
Se o escore < 12, mecanismos neuropáticos são improváveis de estarem contribuindo para a dor do paciente.
Se escore ⱖ 12, mecanismos neuropáticos provavelmente estão contribuindo para a dor do paciente.
1550